What Does Obamacare Cover in California?

Posted by Shreya Vishnoi on May 3rd, 2017

Obamacare is a healthcare reform legislation whose aim is to make health insurance accessible and affordable to Americans. The law establishes government run websites which are also known as exchanges or Marketplaces. If you don’t have health coverage, you can visit these platforms to purchase it. The health exchange set up for California is known as Covered California.

If you have health insurance (for instance, through your employer), you may not need to make any changes on your coverage. But, if you don’t have health coverage and don’t qualify for exemption, you might face a tax penalty through Obamacare unless you choose to enroll in a health plan.
Who qualifies for the health coverage?

The Affordable Care Act requires that most people who are U.S. nationals, U.S. citizens and lawfully present immigrants to have the health coverage. Therefore, those eligible for the healthcare coverage include:

• U.S. nationals and U.S. citizens
• Lawful permanent residents or green card holders
• Persons fleeing any form of persecution, and these also include asylees and refugees
• Lawful temporary residents
• Non-immigrant Status holders (which includes student and worker visas)
• Other humanitarian immigrants, which include those given temporary protected status

Types of health plans available on California’s health insurance exchange

The health plans available on Covered California Obamacare do fit into four metal levels as follows:

• Bronze level – Averagely, your plan covers 60 percent of healthcare costs and you pay for the remaining 40 percent.
• Silver level – Averagely, your plan pays 70 percent of the healthcare expenses while you take care of the 30 percent.
• Gold level – On average, the plan pays for 80 percent of the healthcare costs; you sort the remaining 20 percent.
• Platinum level – On average, the plan funds 90 percent of healthcare costs and you fund the other 10 percent.   

Enhanced silver plans

These plans aim at helping people with limited income that qualify for reduced out-of-pocket costs. Under this plan, eligible persons who buy the Silver plan will enjoy lower cost-sharing benefits of the Platinum and Gold plans.

The three main types of Enhanced Silver plans include:

• Plan pays 94 percent: Averagely, the health plan pays 94 percent while you pay the other 6 percent.
• Plan pays 87 percent: On average, the health plan funds 87 percent, and you fund the other 13 percent.
• Plan pays 73 percent: On average, the health plan funds 73 percent, whereas you pay the other 27 percent.

Minimum coverage plans

This coverage option applies to you if you:

• Are below 30 years old
• Cannot afford the usual health coverage or are otherwise eligible for a hardship exemption.

Minimum plans do cover similar minimum benefits as do the marketplace plans. Although the plans have lower premiums compared to other health plans, you should meet a high deductible before this plan starts paying for most medical expenses.

In California, the plans cover certain benefits even before one reaches the deductible. Generally, you won’t be required to pay coinsurance or copayments for these benefits:

• Three doctor visits
• Outpatient substance abuse or mental health care
• Free preventive benefits
• Urgent care visits

Essential health benefits covered by Obamacare health plans

In California and the entire United States, all of the healthcare plans available must meet the following health benefits:

• Emergency care
• Hospitalization services
• Ambulatory services
• Laboratory services
• Prescription medication
• Mental health or substance abuse services
• Care for maternity and newborns
• Rehabilitative equipment and services
• Pediatric services
• Preventive and wellness care

Enrolling for a health plan

As a California resident, you can use the following options to find health coverage:

A licensed insurance broker

The state health insurance exchange – Covered California Obamacare

Directly through a reputed insurance company such as Rais Insurance.